Breast Cancer Poster Request Form
Enter your details, select the posters you need, and confirm the medical-use terms to receive digital copies.
Section 1: Your Details
Full name
First Name
Last Name
Email address
example@example.com
Phone number with country code
Please enter a valid phone number.
Format: (000) 000-0000.
Title or role
Organization or facility name
City and country
Section 2: Poster Request
How and where will you use the posters?
Which posters would you like?
Breast Cancer Care: Don’t Wait
How is Breast Cancer Confirmed (Diagnosed)?
Detecting Breast Cancer
Breast Cancer Signs and Symptoms
Recovery Exercises after Breast Cancer Surgery
Chemotherapy for Breast Cancer
How many copies of each poster do you plan on printing?
Section 3: Terms of Use
Terms of use acknowledgment (all must be accepted):
*
Medical and educational use only: I will use the posters only for medical, health education or patient awareness purposes, such as in clinics, hospitals, screening programs or community health events. I will not use them for commercial, promotional, political or fundraising purposes, and I will not sell them or charge anyone for them.
No changes to the posters: I will display and share the posters exactly as provided. I will not edit, crop, translate, redesign or add to any part of the posters, including the text, images, colors, logos and references. I will contact PMABC first if a change or translation is needed.
PMABC ownership and credit: I acknowledge that PMABC (Precision Medicine for Aggressive Breast Cancer) is the sole owner of the posters and all of their content. I will keep all PMABC logos and credits visible. I will not claim the posters as my own or my organization’s, and I will not share the digital files with anyone without PMABC's permission.
Sign to Submit
Type your full name as your signature
*
Date
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please verify that you are human
*
Signature
Submit Request
Submit Request
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